doctor wants me to reduce prednisone

[Uzziah7]

on 10 mg of prednisone for PMR that seem to be my magic number, when I try to go lower usually have a flare, doctor wants me to try methotrexate, what are some thoughts

[Dream21]

For me, Methrotrexate did nothing, but everyone is different. The last 10mg were the hardest part of tapering for me. Your adrenal gland needs to start making Cortisol again. I was very tired. I had an endocrinologist test my adrenal gland to make sure I was producing cortisol again. Everything was normal, but extremely tired during taper and took a month for energy to return. Be patient and gentle with yourself during this time. It will get better. Taper slowly. Good luck on your taper.

[Uzziah7 in reply to Dream21]

Thanks for your reply

[Hidden]

Hi uzziah7

It's a difficult decision. You started on a high dose so have done well to get to 10. I was DX in June 2016 and got to 8mg and had flare in the Oct/Nov. Since last June I have been on a dmard like mxt. I have got down to 8mg with no flares so far. However, it has taken a year to reduce from 15mg to 8mg and really in all honesty I may have got to 8mg anyway as I have tapered slowly using dead slow nearly stop. I also reduce by 0.5mg sometimes. Some people benefit from mxt others not so much. Perhaps trying 0.5mg drops on Dsns method might work. I always stay on new lower dose for a few weeks. I am at the 3rd week of 8mg and if all ok I will drop to 7.5mgin a week or two. So day 1 I will take 7.5mg then 6 days of 8mg, 1 day of 7.5mg then 5 days of 8mg, 1 day of 7.5mg then 4 days of 8mg and so on until I am at 7.5mg daily. Sorry if I am teaching grandma to suck eggs. Hopefully you will get more feedback from others who have gone the mext route. Good luck🌻

[Uzziah7 in reply to Hidden]

Thanks for your reply

[DorsetLady PMRGCAuk volunteer]

Is this the same doctor that started you at 40mg for PMR? If so, he seems to have some strange views on treating illness.

As you are only 2 years “in” then maybe 10mg is what you need at the moment!

As Poopadoop says a better way would be to try 0.5mg steps and a slow tapering plan.

My personal opinion (not proven) is why add in another drug with more side effects unless it is absolutely necessary.

I think if you try things more slowly and without being pressured by doctor you may find you can reduce the Pred.

Good luck.

[Uzziah7 in reply to DorsetLady]

Thanks for your reply

[PMRpro Ambassador]

It took me four years to get below 10mg at all so being on 10mg after 2 years and starting at 40mg is pretty good I'd have said. I wouldn't agree to methotrexate after 2 years. There is evidence (they say) that it works better in GCA when started in the first month. Once you get to 2 years I think it is reasonable to wait longer and taper with one of the very slow plans to be found on the forum. The average duration of pred for PMR is 5.9 years - but most GPs are unlikely to have read the paper (nor rheumies either if it comes to that). Your doctor doesn't sound like someone who looks at guidelines...

practicalpainmanagement.com...

My personal opinion now is that if you can take methotrexate without side effects (and it is possible) then it is worth a try. But with a very low threshold for side effects and saying no and not after only two years, then slow tapering should come first. My rheumy is now agitating - but it is after 9 years of pred and being still stuck at 8mg or so.

[Uzziah7 in reply to PMRpro]

Thanks for your reply